Infant and child mortality in Zimbabwe : an analysis of levels, trends, differentials and determinants
Date
1995
Authors
Jhamba, Tapiwa
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Abstract
This study examined levels, trends, differentials and determinants of infant and
child mortality in Zimbabwe covering the period from the late 1960s to the early 1990s.
The study was based on data collected in the 1982 Census, the 1992 Census and three
nationally representative surveys: the 1984 Zimbabwe Reproductive and Health Survey
(ZRHS), the 1987 Inter-Censal Demographic Survey (ICDS) and the 1988 Zimbabwe
Demographic and Health Survey (ZDHS). Infant and child mortality differentials and
determinants were examined, first at the provincial and district level using the 1992
Census, and second at the individual woman level using the 1984 ZRHS, 1987 ICDS and
1988 ZDHS, and lastly at the individual child level using the birth history data from the
1988 ZDHS.
At the national level, infant and child mortality declined significantly through the
1970s and 1980s with signs of a stagnation or an upward trend around 1990. Results
from the 1992 Census show that substantial district variations in infant and child
mortality exist in Zimbabwe. A high mortality belt exists along the borders with
Mozambique in the east and north-east and the border with Zambia in the north. The
district variations are associated with levels of female education, fertility level and
population density. It is argued that the district variations are generally related to broader
characteristics which include natural environmental conditions, levels of socioeconomic
development, and ethnic and cultural factors which may influence beliefs, practices and
the diffusion of health related information.
With respect to individual children, maternal age and birth order had significant
independent effects on infant mortality but not child mortality, indicating that their effects
were mainly biological and related to circumstances at birth. Short preceding birth
intervals of 18 months or less were associated with significantly higher infant and child
mortality and the effects were independent of the survival of the preceding sibling,
indicating that sibling competition was not the main mechanism of influence. Also,
shorter succeeding birth intervals were associated with higher probabilities of dying between ages one and five years, a likely effect of interruption of breastfeeding. The
survival of successive siblings was correlated, which indicates the existence of common
endogenous, environmental or family level factors affecting successive siblings.
Differentials by sex of child did not show any evidence of the effects of sex preference on
infant and child mortality.
Characteristics of mothers that were significantly related to the mortality of their
children include place of residence, education, age at marriage, ever-use of modem
contraception, and whether or not the mother had pre-natal care for the last child. Place
of residence and use of modem contraception were particularly important during infancy
while maternal education and province of residence were important between ages one
and five years. Higher maternal education, ever-use of modem contraception and
residence in urban areas, the effects of which were largely independent of maternal
reproductive characteristics, may indicate better maternal knowledge concerning
nutrition, hygiene and curative and preventive medical care, and access to health
services. This study found that the levels and factors affecting infant and child mortality
vary according to the economic and social organisation of the place of residence. Child
mortality was highest on commercial farms, lowest in urban areas and intermediate in
communal areas. In communal areas, household possession of cattle and an ox-drawn
cart, and paternal occupation were significantly associated with infant mortality, and the
availability of a toilet facility had significant effects on child mortality.
In the long term, the combination of higher educational attainment by women,
increase in age at marriage, delay in age at first pregnancy, use of modem contraception,
longer birth spacing, increase in utilisation of health services and promotion of public
health awareness are expected to further reduce infant and child mortality in Zimbabwe.
This would only be realised if the effects of the economic structural adjustment program
(ES AP) on provision of health and other social services is minimal and that he spread of
HIV and AIDS is controlled, otherwise infant and child mortality will indeed increase.
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